Amy M. Miller, Ph.D., is executive vice president of the Personalized Medicine Coalition (PMC), an organization that “promotes the understanding and adoption of personalized medicine concepts, services and products to benefit patients and the health system.” Although there is a bright spotlight on the field of personalized medicine thanks to the Obama administration’s Cancer Moonshot and Precision Medicine initiatives, there are real concerns about how targeted medicines will be considered in value assessment frameworks, which are geared toward evaluating treatments for a population rather than individual patients.
This week, National Pharmaceutical Council (NPC) President Dan Leonard sat down with Dr. Miller to discuss these issues.
Dan Leonard (DL): Amy, thank you for joining me to talk about personalized medicine and value frameworks. Tell us a little about personalized medicine and its impact on patient care, especially in light of ongoing debates about costs, coverage and value.
Amy Miller (AM): Thank you for this opportunity. Personalized medicine is an evolving field in which physicians use diagnostic tests to determine which medical treatments will work best for each patient. By combining the data from those tests with an individual’s medical history, circumstances and values, health care providers can develop targeted treatment and prevention plans. This concept challenges how health care products and services are discovered, developed, regulated, covered, paid for and delivered in the clinic. Therefore, it is no surprise that personalized medicine challenges how value assessments are conducted.
DL: The basis for personalized medicine is that every patient is unique and will respond to treatments differently, something NPC also has demonstrated in our research. How can a value assessment framework take that important concept into consideration?
AM: Fortunately for value assessment framework designers, many organizations have published suggestions for them. It is important for the value assessment questions to accurately reflect available data. Furthermore, when looking at disease areas with targeted therapeutics, value assessment frameworks must look at the full complement of clinical tools, including the diagnostic test or tests and the clinical outcome differences between a targeted and non-targeted treatment approach.
DL: The Institute for Clinical and Economic Review (ICER) is currently evaluating treatments for non-small-cell lung cancer (NSCLC), a disease that is unique to each patient and requires targeted treatment. They’ll be hosting a public meeting about that evaluation on October 20. What kinds of factors should ICER be considering as part of its review of NSCLC treatments?
AM: NSCLC is a disease where personalized medicine has transformed care over the last decade, and patients have seen tremendous improvements in morbidity, mortality and quality of life as a result. We’ve seen evolution in treatments targeting many driver mutations in the tumor. We’ve seen evolution in the types of diagnostics used to select those treatments. I think ICER needs to carefully consider all that we’ve learned over the last decade using EGFR-mutation therapeutics, value those therapeutics from a patient’s perspective, and consider how we incentivize investments in PD-1 therapeutics so we can capitalize on their tremendous potential in a similar way. PD-1 inhibitors work quite well for a subset of patients, but we do not know how best to use them yet. We will figure it out, and when we do, it will likely have tremendous implications for patients, giving them longer, better lives than comparators like chemotherapy.
DL: What have you heard from your member companies about ICER’s review of NSCLC treatments? Are there ways that ICER could better integrate those comments, as well as patient input?
AM: ICER concurrently opened a public comment period where stakeholders could suggest process changes. One example of a process change that ICER could make now is to include a more representative group of stakeholders on its advisory council. Furthermore, historically, ICER has discussed the implications of its decision after a vote on the value assessment. Simply listening to the public before voting would reassure stakeholders that ICER values their input.
DL: You had asked ICER to provide a longer comment period for NSCLC, which they granted. Do you think that was enough time? How could they improve the comment process in the future?
AM: PMC is a coalition representing pharmaceutical manufacturers, diagnostic companies, patients, providers, payers and other stakeholders, and the perspectives that these groups have together are often valuable to those who seek input on their work. However, for a coalition to engage a group like ICER requires that our members consider the issues from their perspective before joining a conversation about how to support a concept. ICER’s comment period (30 days and, in this case, including holidays) did not allow for us to engage. For a document of this magnitude and import, we suggested allowing for a 60-90 day comment period, which conforms to other organizations’ timelines. We hope they will consider that.
DL: These are exciting times for personalized medicine, with rapid developments in understanding this science and finding new cures. With these developments, how could—or should—ICER update its reports to remain current?
AM: In the case of NSCLC, new clinical evidence was published during ICER’s comment period, and for PD-1 inhibitors, I think we’ll see new data coming in more than once a year going forward. Because ICER is not alone in the value assessment trade, I’d suggest that the field of value assessment coordinate and come up with best practices for updating their findings. That way, innovators, patients and providers will have a timetable to engage with the update.
DL: Thanks so much for speaking with me.
To learn more about personalized medicine, visit PMC’s website.
For more about value framework assessments, check out NPC’s Guiding Practices for Patient-Centered Value Assessment and Current Landscape: Value Assessment Frameworks and watch the video from our conference, Assessing Value: Promise and Pitfalls.